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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300613958
Report Date: 06/29/2023
Date Signed: 06/29/2023 04:36:01 PM

Document Has Been Signed on 06/29/2023 04:36 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:CENTRAL ORANGE COAST YMCA - LOMA VISTA SCHOOLFACILITY NUMBER:
300613958
ADMINISTRATOR:JUAN MARTINEZFACILITY TYPE:
840
ADDRESS:13822 PROSPECT AVE.TELEPHONE:
(714) 730-0541
CITY:SANTA ANASTATE: CAZIP CODE:
92705
CAPACITY: 92TOTAL ENROLLED CHILDREN: 92CENSUS: 27DATE:
06/29/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Director Kandyce Piraino TIME COMPLETED:
05:00 PM
NARRATIVE
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On 06/29/2023, an unannounced case management inspection was conducted by Licensing Program Analyst (LPA) Anna Chan who met with the Director, Kandyce Piraino and Director of Operations, Dorain Cassell. Upon arrival there were 7 staff present and 27 school-age children in care.

A review of criminal record clearances indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

On 6/15/2023 a self-reported incident by the facility was received at the regional office. It was reported that Child #1 (C1), Child #2 (C2), Child #3 (C3), were left unsupervised in the public restroom during field trip on 06/14/2023 at Triangle Cinema in Costa Mesa.

During this investigation, LPA interviewed Director, and 1 staff present at the time the incident happened. LPA obtained a copy of the children list for the fieldtrip and Personnel Summary Report. Based on interview, Staff # 1 (S1) stated S1 accompanied 7 children, C1, C2, C3, C4, C5, C6, C7 (4 girls and 3 boys) to the theater restroom. While waiting outside the girl’s restroom, C5 needed to go to the boy’s restroom. S1 tried to call the 4 girls but only C4 went out. S1 saw another Staff #2 (S2) from their sister school (YMCA-Benson) in the restroom and S1 left. S1 walked C5, C6, C7 and C4 to the boy’s restroom and left the 3 girls in the girl’s restroom unsupervised. When S1 and the other 4 children walked back to the girl’s restroom, C1, C2 and C3 were waiting outside the restroom with S2. There is no communication from S1 leaving the children to S2; S2 waited with the 3 children until S1 returned. The girl’s and boy’s restroom are about 50 feet apart with theater concessions in between both bathrooms according to the director.

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SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Anna Francesca Chan
LICENSING EVALUATOR SIGNATURE: DATE: 06/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/29/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
Document Has Been Signed on 06/29/2023 04:36 PM - It Cannot Be Edited


Created By: Anna Francesca Chan On 06/29/2023 at 03:54 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: CENTRAL ORANGE COAST YMCA - LOMA VISTA SCHOOL
FACILITY NUMBER: 300613958

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/29/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/30/2023
Section Cited
CCR
101229(a)(1)

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101229 Responsibility for Providing Care and Supervision(a)The licensee shall provide care and supervision... to meet the children's needs.(1)No child(ren) shall be left without the supervision of a teacher at any time...
This requirement is not met as evidenced by:
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DIrector stated that a staff emergency meeting and training was conducted following the incident. Director of operations stated that the facility hired new employees.
A copy of the meeting agenda will be provided to LPA by due date on 6/30/23
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Based on interview, C1, C2, and C3 were left unsupervised in the public restroom for 5 minutes during an out of school field trip.

This poses an immediate risk to children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Rina Lopez
LICENSING EVALUATOR NAME:Anna Francesca Chan
LICENSING EVALUATOR SIGNATURE:
DATE: 06/29/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/29/2023


LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: CENTRAL ORANGE COAST YMCA - LOMA VISTA SCHOOL
FACILITY NUMBER: 300613958
VISIT DATE: 06/29/2023
NARRATIVE
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Based on children interview C1 is not aware being left unsupervised by S1. On another interview with C2 and C3, they were aware that they were left unsupervised when they tried looking for S1. C3 stated another teacher S2 was there but S2 is not part of their group.

Based on the information gathered from the interviews conducted, and records reviews, it was determined that C1, C2, C3, were left unsupervised for approximately 5 minutes at 1pm while on a field trip to the movie theater.

The facility was not in compliance of the California Code of Regulations, Title 22, Division 12. The following citation Responsibility for Providing Care and Supervision section 101229(a)(1) was issued today on the attached LIC 809D.

LPA Chan informed director Kandyce Piraino that this report dated 06/29/2023 for Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.

LPA Chan informed the director Kandyce Piraino to provide a copy of this licensing report dated 06/29/2023, which has a Type A citation, must be provided to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview conducted and report was reviewed with the Director Kandyce Piraino. A notice of site visit was posted on the door and must remain posted for 30 days. Appeal Rights and deficiencies were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First level appeals should be sent to the regional manager to the address listed above.



Page 2 of 2 End of Report
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Anna Francesca Chan
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2023
LIC809 (FAS) - (06/04)
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